• EUS
• midazolam
• pentazocine
• pethidine hydrochloride
• sedation

• Ciprofol
• Intravenous lidocaine
• Painless gastrointestinal endoscopy

• Humans
• Lidocaine/administration & dosage
• Double-Blind Method
• Male
• Female
• Middle Aged
• Anesthetics, Local/administration & dosage
• Endoscopy, Gastrointestinal/methods
• Adult
• Infusions, Intravenous
• Dose-Response Relationship, Drug
• Patient Satisfaction
• Aged
• Anesthesia Recovery Period
• Cyclopropanes

• dexmedetomidine
• endoscopic retrograde cholangiopancreatography (ercp)
• hemodynamic stability
• ketamine
• propofol
• recovery time
• sedation
• total intravenous anaesthesia

• endoscopy
• midazolam
• monitored anesthesia care
• mri
• non-operative

• bis
• endoscopic retrograde cholangiopancreatography (ercp)
• monitored anesthesia care
• procedural sedation and analgesia
• tci

• colonoscopy
• diagnostic and therapeutic endoscopy
• elderly
• endoscopic procedures
• gastrointesinal endoscopy

• Humans
• Gastroenterology
• Conscious Sedation
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Propofol
• Benzodiazepines

• Humans
• Gastroenterology
• Endoscopy, Gastrointestinal
• Gastrointestinal Tract
• Metabolic Diseases

Propofol sedation for advanced endoscopic procedures is a widespread technique at present, which generates controversy worldwide when anaesthetic or non-anaesthetic personnel administer this form of sedation. There is some evidence for safe administered propofol sedation by non-anaesthetic personnel in patients undergoing endoscopy procedures, but there are only few randomised trials addressing the safety and efficacy of propofol in patients undergoing advanced procedures. A serious possible consequence of propofol sedation is the rapid and unpredictable progression from deep sedation to general anaesthesia mostly when elderly and frail patients are involved in the diagnosis or treatment of various neoplasia. This situation requires rescue measures with skilled airway management. The aim of this paper is to review the safety and efficacy aspects of sedation techniques, with special reference to propofol administration covering the whole patient journey, including preassessment, sedation options and discharge when advanced endoscopic procedures are performed.

Ciprofol is a propofol analogue with improved pharmacokinetic properties. A multi‐centre, non‐inferiority trial was conducted to compare the deep sedation properties of ciprofol and propofol with a non‐inferiority margin of 8% in patients undergoing gastroscopy and colonoscopy. In total, 289 patients were randomly allocated for surgery (259 colonoscopy and 30 gastroscopy) at a 1:1 ratio to be given intravenous injections of ciprofol (0.4 mg/kg) or propofol (1.5 mg/kg). The primary outcome was the success rate of colonoscopy defined as colonoscopy completion with no need for an alternative sedative or >5 ciprofol or propofol top up doses within any 15‐min time period. The success rate of colonoscopy was 100% in the ciprofol group vs. 99.2% in the propofol group (mean difference 0.8%, 95% CI: −2.2% to 4.2%). Except for the gastrointestinal lesions found during the gastroscopy and colonoscopy procedures, the occurrence rates of adverse drug reactions in the ciprofol and propofol groups were 31.3% and 62.8%, respectively (P < 0.001). Pain on injection was less common in the ciprofol group (4.9% vs. 52.4%, P < 0.001). The outcomes demonstrated that ciprofol was non‐inferior to propofol with regard to successful sedation for gastroscopy or colonoscopy procedures and no obvious important adverse events occurred.

• ciprofol
• colonoscopy
• deep sedation
• gastroscopy
• propofol

• Anesthesia
• Conscious Sedation/adverse effects
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Female
• Hospitals
• Humans
• Hypnotics and Sedatives/adverse effects
• Male
• Midazolam
• Middle Aged
• Propofol/adverse effects

• CiteSpace
• VOSviewer
• bibliometric analysis
• co-citation analysis
• endoscopic sedation
• hot spots

• Conscious Sedation
• Endoscopy, Gastrointestinal
• Hospitals
• Humans
• Hypnotics and Sedatives
• Singapore

• Endoscopic retrograde cholangiopancreatography
• Intravenous lidocaine
• Propofol
• Sedation

• gastroenterological endoscopy
• patient monitoring
• pre-sedative assessment
• sedation
• training

The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.

In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.

Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.

Propofol sedation was found to be safe-without severe adverse events or accidents-for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.

• Cancer screening
• Endoscopic ultrasonography
• Esophagogastroduodenoscopy
• Propofol
• Sedation

Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. To date, there is lack of consensus regarding who should administer sedation in these patients. Several studies have investigated the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data regarding anesthesiologist-administered sedation remain limited. This prospective single-center study investigated the safety and efficacy of anesthesiologist-administered sedation and the rate of successful performed ERCP procedures.

The study included 200 patients who underwent ERCP following anesthesiologist-administered sedation with propofol and remifentanil. Procedural data, oxygen saturation, systolic blood pressure (SBP), heart rate, recovery score, patient and endoscopist satisfaction, as well as 30-day mortality and morbidity data were analyzed.

Sedation-related complications occurred in 36 of 200 patients (18%) and included hypotension (SBP < 90 mmHg) and hypoxemia (O₂ saturation < 90%) in 18 patients (9%) each. Most events were minor and did not necessitate discontinuation of the procedure. However, ERCP was terminated in 2 patients (1%) secondary to sedation-related complications. Successful cannulation was performed in all patients. The mean duration of the examination was 25 ± 16 min. Mean recovery time was 14 ± 10 min, and high post-procedural satisfaction was observed in both, patients (mean visual analogue scale [VAS] 9.6 ± 0.8) and endoscopists (mean VAS 9.3 ± 1.3).

This study suggests that anesthesiologist-administered sedation is safe in patients undergoing ERCP and is associated with a high rate of successful ERCP, shorter procedure time, and more rapid post-anesthesia recovery, with high patient and endoscopist satisfaction.

• Anesthesia
• ERCP
• Endoscopic retrograde cholangiopancreatography
• Hypotension
• Hypoxemia
• Sedation

Propofol is commonly used for sedation during endoscopic procedures. Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved post-procedure recovery times for patients. However, Propofol requires administration by trained healthcare providers, has a narrow therapeutic index, lacks an antidote and increases risks of cardio-pulmonary complications.

To compare, through a systematic review of the literature and meta-analysis, sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.

A literature search was performed using MEDLINE, Scopus, EMBASE, the Cochrane Library, Scopus, LILACS, BVS, Cochrane Central Register of Controlled Trials, and The Cumulative Index to Nursing and Allied Health Literature databases. The last search in the literature was performed on March, 2019 with no restriction regarding the idiom or the year of publication. Only randomized clinical trials with full texts published were included. We divided sedation therapies to the following groups: (1) Propofol versus benzodiazepines and/or opiate sedatives; (2) Propofol versus Propofol with benzodiazepine and/or opioids; and (3) Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid. The following outcomes were addressed: Adverse events, patient satisfaction with type of sedation, endoscopists satisfaction with sedation administered, dose of propofol administered and time to recovery post procedure. Meta-analysis was performed using RevMan5 software version 5.39.

A total of 23 clinical trials were included (n = 3854) from the initial search of 6410 articles. For Group I (Propofol vs benzodiazepine and/or opioids): The incidence of bradycardia was not statistically different between both sedation arms (RD: -0.01, 95%CI: −0.03–+0.01, I²: 22%). In 10 studies, the incidence of hypotension was not statistically difference between sedation arms (RD: 0.01, 95%CI: −0.02–+0.04, I²: 0%). Oxygen desaturation was higher in the propofol group but not statistically different between groups (RD: −0.03, 95%CI: −0.06–+0.00, I²: 25%). Patients were more satisfied with their sedation in the benzodiazepine + opioid group compared to those with monotherapy propofol sedation (MD: +0.89, 95%CI: +0.62–+1.17, I²: 39%). The recovery time after the procedure showed high heterogeneity even after outlier withdrawal, there was no statistical difference between both arms (MD: -15.15, 95%CI: −31.85–+1.56, I²: 99%). For Group II (Propofol vs propofol with benzodiazepine and/or opioids): Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioid-associated (RD: -0.08, 95%CI: −0.13–−0.02, I²: 59%). There was no statistical difference in the incidence of bradycardia (RD: -0.00, 95%CI: −0.08–+0.08, I²: 85%), desaturation (RD: −0.00, 95%CI: −0.03–+0.02, I²: 44%) or recovery time (MD: -2.04, 95%CI: −6.96–+2.88, I²: 97%) between sedation arms. The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity. (MD: 70.36, 95%CI: +53.11–+87.60, I²: 61%). For Group III (Propofol with benzodiazepine and opioid vs benzodiazepine and opioid): Bradycardia and hypotension was not statistically significant between groups (RD: -0.00, 95%CI: −0.002–+0.02, I²: 3%; RD: 0.04, 95%CI: −0.05–+0.13, I²: 77%). Desaturation was evaluated in two articles and was higher in the propofol + benzodiazepine + opioid group, but with high heterogeneity (RD: 0.15, 95%CI: 0.08–+0.22, I²: 95%).

This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.

• Sedation
• Digestive endoscopy
• Propofol
• Benzodiazepines
• Opioids
• Adverse events

Background: The incidence of sedation-related adverse events, inclusive of both adults and children, administered by multiple specialty providers from different countries and venues, using standardized definitions, has never been reported on an international level. We are reporting the outcome data of the adverse event sedation reporting tool as an important step toward a more complete risk assessment of sedation-related morbidity, mortality, and etiology. The analysis of the AE sedation reporting data include descriptive measures to evaluate the characteristics of the provider, the patient, sedations performed, adverse events, interventions, and outcomes. The primary outcome was the rate and nature of adverse events. Between 12/14/2010 and 12/11/2018 there were 7952 sedations, from an estimated total of 164,114 sedations administered, of which 622 were reported as adverse events. The mean age of the entire patient population is 33.0 years (0.02–98.7). The providers represented 39 countries across six continents. Oxygen desaturation (75%–90%) for <60 s is the most prevalent adverse event with a rate of 7.8 per 10,000, followed by airway obstruction at a rate of 5.42 per 10,000. Apnea occurred at a rate of 4.75 per 10,000. Significant predictors of adverse events are ≥ ASA score III (p = 0.0003), procedure time (6:00 pm–12:00 am: p < 0.0001, 12:00–6:00 am: p = 0.0003), and non-hospital location (p < 0.0001). The AE sedation reporting tool has demonstrated that the majority of adverse events in children and adults who receive procedural sedation from multi-specialists internationally required minor interventions and had outcomes of minor risk.

• adults
• children
• pediatrics
• safety
• sedation

• adverse events
• anesthesia
• endoscopic retrograde pancreatography
• endoscopy
• sedation

• Propofol
• anesthesiology
• balanced propofol sedation
• endoscopic retrograde cholangiopancreatography
• endoscopy
• moderate sedation

Gastrointestinal endoscopy under anesthesia has been carried out as a routine procedure in China. Hypoxemia is still an adverse event with a high incidence in routine anesthesia for gastrointestinal endoscopy, but the incidence of hypoxemia varies greatly across countries (< 1% to 85%), and there is a lack of relevant high-quality reports in China. Propofol, as a sedative for anesthetic gastroscopy in outpatients, has been recognized for its safety and effectiveness and is recommended by the expert consensus on Sedation/Anesthesia for Digestive Endoscopic Diagnosis and Treatment in China (2014). However, there are still some debate over its safety in foreign countries. In this study, we used propofol as a sedative for gastroscopy in outpatients to observe its effect on the incidence of hypoxemia.

To observe and analyze the incidence of and risk factors for hypoxemia in anesthesia for gastrointestinal endoscopy.

A total of 580 outpatients who were sedated with propofol from September 1, 2018 to November 30, 2018 in Digestive Endoscopy Center of Shanghai Changhai Hospital were included in the study. These patients were divided into either a hypoxemia (n = 110) group or a non-hypoxemia group (n = 470). The basic information, anesthesia procedure, and endoscopic operation related information of the two groups were recorded.

The information of patients in the two groups was compared and analyzed. It was found that there were significantly differences between the two groups in snoring history, biopsy, age, body mass index, abdominal circumference, endoscopic operation time, propofol dosage, ASA classification, and endoscopic physician classification (P < 0.05). Multivariate Logistic regression analysis showed that age (>5 years, OR = 8.955, 95 %CI: 2.070-38.746) and propofol dosage (>197 mg, OR = 2.360, 95 %CI: 1.320-4.219) were independent risk factors for hypoxemia.

Intervention is needed for elderly patients (especially patients over 75 years old) and patients requiring large amounts of propofol (especially > 197 mg) to prevent the occurrence of hypoxemia.

• Anesthesia/sedation
• Gastrointestinal endoscopy
• Hypoxemia
• Risk factors

• Midazolam
• agitation
• elderly demented patients
• oral route
• tolerability

• Clinical Competence
• Deep Sedation/adverse effects
• Deep Sedation/standards
• Humans
• Hypnotics and Sedatives/adverse effects
• Patient Safety
• Propofol/adverse effects

• endoscopy
• midazolam
• pethidine
• propofol

• Gastrointestinal Endoscopy
• Propofol
• Safety
• Sedation

• Ascites
• Cirrhosis
• GI bleeding
• Liver transplantation
• Portal hypertension
• TIPS

• Advanced Endoscopic Procedures
• Colonoscopy
• Endoscopy
• Meta-Analysis
• Outcomes
• Propofol
• Traditional Sedative Agents

• Anesthesia/adverse effects
• Anesthetics, Intravenous/administration & dosage
• Anesthetics, Intravenous/adverse effects
• Arrhythmias, Cardiac/chemically induced
• Arrhythmias, Cardiac/epidemiology
• Endoscopy, Gastrointestinal
• Humans
• Hypotension/chemically induced
• Hypotension/epidemiology
• Hypoxia/chemically induced
• Hypoxia/epidemiology
• Propofol/administration & dosage
• Propofol/adverse effects
• Risk Assessment

• Apnea
• Endoscopic resection
• Endoscopic sedation
• Endoscopic ultrasound
• Gastrointestinal endoscopy
• Hypoxemia
• Midazolam
• Propofol

• gastrointestinal endoscopy
• meperidine
• midazolam
• moderate sedation
• propofol

• Conscious sedation
• Curriculum
• Deep sedation
• Education
• Endoscopy
• Gastrointestinal
• Graduate
• Medical

• Clinical Competence
• Conscious Sedation/standards
• Deep Sedation/standards
• Endoscopy, Gastrointestinal/standards
• Gastroenterology/education
• Humans
• Hypnotics and Sedatives/therapeutic use
• Informed Consent
• Monitoring, Intraoperative
• Monitoring, Physiologic
• Postoperative Care
• Propofol/therapeutic use
• Risk Assessment
• Simulation Training

• Ablation technique
• Barrett’s esophagus
• Conscious anesthesia
• Intraoperative complication